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GI: Diarrhea - Ascites Flashcards

1
Q

PTs may define diarrhea as ?

A

Frequent, more than 3/day
Loose, watery
Urgency

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2
Q

What is the criteria for persistent diarrhea

What is the limit for chronic diarrhea?

A

Diarrhea lasting between 2 and
4 wks
+4 wks

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3
Q

What are two important considerations in the work up for diarrhea?

A

Acute vs Chronic

Non vs Inflammatory

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4
Q

Etiology of acute diarrhea

A

Are these present?
Severe illness (<7days; Fever, Pain, Bloody diarrhea, +6 BMs/24hr, Dehydration)
Immunocompromised
Elderly +70yrs

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5
Q

What is the next step for treating acute diarrhea if the severe illness, immune compromise of non-elderly criteria are NOT met?

A

Sx therapy: anti-diarrhea- loperamide, bismuth subsalicylate

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6
Q

What is the next step when treating acute diarrhea and the severe illness, immune compromise of non-elderly criteria are ARE met or illness is present after 7-10 days after Sx therapy?

A 
Stool sample for:
Fecal leukocyte
Routine stool culture
C Diff
Ova/parasite testing- if travel, +10day, water outbreak, relationship criteria is met
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7
Q

Acute diarrhea meeting severe illness/immune/elder criteria or or lasting 7-10 days after Sx therapy will have stool samples tested for ova/parasite. Empiric ABX therapy is considered while waiting culture if ?

A 
\+ fecal leukocyte
Bloody diarrhea
Fever
Ab pain
Dehydration/ +8 BMs/24hrs
Immunocompromised
Hospitalization REQ'D
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8
Q

Acute diarrhea lasting less than 2wks is most commonly caused by ?

A

Acute non-inflamm: virus, non-invasive bacteria

Acute inflamm: invasive or toxing producing bacteria

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9
Q

Characteristics of acute inflammatory diarrhea?

A

Blood, pus or fever
Invasive/toxin producing bacteria
Stool cultures: E Coli O157:H5 and O157:H7, C Diff and Ova/parasite

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10
Q

What are the Viral causes of noninflammatory diarrhea?

A 
Norovirus*
Rotavirus*
Astrovirus
Adenovirus
Sapovirus
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11
Q

What are the Protozoal causes of non-inflammatory diarrhea?

A

Giardia*
Crytposporidium
Cyclospora

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12
Q

What are the bacterial causes of non-inlfammatory diarrhea?

A

Preformed enterotoxins= Staph A, Bacillus Cereus, Clostridium Perfringens
Enterotoxin production= E Coli ETEC, V Cholera, Vibrio Vulnificus

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13
Q

What are the viral and protozoal causes of inflammatory diarrhea?

A 
V= cytomegalovirus
P= entamoeba histolytica
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14
Q

What are the bacterial causes of inflammatory diarrhea?

A

Cytotoxin producing- EHEC H5/H7, V parahaemolyticus, C Diff
CYCLASES PY
Mucosal invasion= Shigella, C Jejuni, Salmonella, EIEC, Aeromonas, Plesiomonas, Yersinia entercolitica, Chlamydia, N Gonorrheoae or Listeria Monocytogenes

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15
Q

What are the relevant Hx facts for acute diarrhea?

A 
Bloody vs watery (nonbloody)
Recent travel
Diet/new places
ABX use
Sick contacts
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16
Q

What are the essentials of Dx for non-inflammatory diarrhea?

A 
Duration less than 2wks
Watery, non bloody
Mild, self limited
Virus/non invasive bacteria
SMALL Bowel
Dx eval only if severe/+7 days
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17
Q

What are the common etiologies of non-inflammatory diarrhea?

A

Viral- Norovirus, Rotavirus

Protozoa- Giardia (water park)

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18
Q

What are the S/Sx of non-inflammatory diarrhea?

A 
Loose water stool
10 bm/day
Cramps
Bloat
N/V
Signs of dehydration- dizzy, light headed, OHOTN
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19
Q

What are the essentials of Dx for Acute Inflammatory diarrhea

A

Less than 2wks
Blood, pus, or fever usually caused by invasive/toxin producing bacteria in
LARGE bowel

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20
Q

What does diagnosis evaluation require for Acute Inflammatory Diarrhea?

A

Routine stool culture for E Coli O157:H7

Testing is indicated for C Diff and parasite/ova

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21
Q

What are the common etiologies of Acute Inflammatory Diarrhea?

A

E Coli
Shigella
Salmonella
C Diff- if recent ABX use

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22
Q

What are the Sx of Acute Inflammatory Diarrhea?

A

Loose bloody stools but lower in vol
Fever and severe LLQ pain
Tenesmus

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23
Q

What are the Signs of Acute Inflammatory Diarrhea that prompt evaluation?

A 
Signs of inflammatory diarrhea: fever, WBC +150K, Blood diarrhea w/ severe ab pain
Frail elderly/nursing home PT
Immunocompromised
Nosocomial, onset in 3 days
ABX exposure
Systemic illness
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24
Q

What are the evaluation steps for Non/Inflammatory Diarrhea?

A

Non= Self limited and mild
Labs usually not req’d unless persists +7 days or constant/severe dehydration

Inflammatory= prompt eval for ALL cases

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25
If PT presents with acute diarrhea, what findings/signs prompt a immediate/further evaluation?
Peritoneal findings present with W Diff or STEC
26
What are the lab tests needed for acute diarrhea?
Fecal leukocytes- will be neg in non-inflammatory PTs Stool culture- OP, 3 samples needed C Diff if recent ABX use Fecal Lactoferrin- marker for intestine inflammation
27
What are the general treatment strategies for acute diarrhea?
``` BRAT Avoid high fiber foods, fats, dairy and caffeine Re-hydrate PO liquids Oral rehydration salts ```
28
What pharmacotherapy is recommended for acute diarrhea PTs? | What is the down side/consideration for these?
Antidiarrhea Loperamide Bismuth subsalicylate Used to allow PT to continue work/mission, works AGAINST the body's mechanisms
29
When are ABX considered to be given to Acute Diarrhea PTs?
Not always indicated Non-hospital acquired diarrhea w/ mod/severe fever, tenesmus or bloody stool, or presence of fecal lactoferrin Immunocompromised PTs Significant dehydration
30
Emipiric treatment may be considered for what acute diarrhea PT while their stool cultures are growing?
``` Non-hospital acquired diarrhea w/ mod/severe fever Tenesmus Bloody stool No STEC suspicion Immunocompromised PTs Significant dehydration ```
31
What is the pathophysiology of Traveler's Diarrhea
Most commonly from ETEC in PTs w/ Hx of recent travel that presents w/ abrupt, watery diarrhea, cramping and nausea w/in 10 days of return
32
How is Traveler's Diarrhea managed? ETEC most commonly caused S/Sx
Rehydrate, Cipro, Azithromycin- if pregnant Diarrhea, Ab cramping, Nausea, Bloating
33
What ABX are used for empiric treatment for acute diarrhea?
``` Fluoroquinolones are DOC Ciprofloxacin 500mg BID Ofloxacin 400mg BID Levofloxacin 500mg QD All for 5-7days Others: Trimethoprim-sulfamethoxazole 160/800mg BID Doxycycline 100mg BID ```
34
Are ABX recommended for Traveler's Diarrhea?
Diarrhea onset w/in 10 days of return- ABX can shorten duration by days Rx can also be given to PTs prior to travel
35
What meds are given for inflammatory Traveler's Diarrhea?
``` PO DOC for empiric treatment: Ciprofloxacin 500mg Ofloxacin 400mg or, Levofloxacin 500mg 1/day for 1-3 days Alternatives= Trimethoprimsulfamethoxazole 160/800mg BID Doxy 100mg BID ```
36
What meds are used for Inflammatory Traveler's Diarrhea non-empirically?
Fluoroquinolones- 3 day course but not useful in SE Asia Azithromycin 1 g single dose Rifaximin 200mg TID x 3 days
37
Fluoroquinolones, Azithromycin and Rifaximin are specific treatments for Inflammatory Traverl's Diarrhea that are caused by what microbes?
``` Shigellosis Cholera Extraintestinal Salmonellosis Listeriosis Traveler's D C Diff Giardia Amebiasis ```
38
What meds are used for non-inflammatory Traverl's Diarrhea?
Rifaximin- 200mg BID x 3 days and Azithromycin 1g single dose or 500mg daily x 3 days for EMPIRIC treatment
39
When are PTs with Traveler's Diarrhea considered for admission?
Severe dehydration of IV fluids especially if intolerable to PO fluids Bloody diarrhea Severe ab pain Fever +39.5*C or sepsis +70 y/o or immunocompromisesd w/ worsening diarrhea S/Sx of hemoytic-uremic syndrome
40
What PO fluids are recommended for Traveler's Diarrhea rehydration?
``` Water Gatorade Tea Flat carbonated beverages Or re-hydration salts if necessary ```
41
When considering chronic diarrhea, what exclusions must be ruled out?
``` Causes of acute Lactose intolerance IBS Previous gastric surgery/ileal resection Parasitic infection Meds Systemic Dz ```
42
What labs/tests are done for a chronic diarrhea PT?
Fecal leukocytes and occult blood Colonoscopy with biopsy Small bowel imaging with barium, CT or MRE
43
What does it mean if chronic diarrhea labs/tests come back abnormal?
Inflammatory bowel dz | Cancer
44
What is the next step if chronic diarrhea labs/tests come back abnormal?
Stool E+, osmolality, weight/24hrs and quantitative fat ALMOST ALL CASES REFERRED TO GI
45
What are the next steps/considerations if chronic diarrhea PT has an increased osmotic gap?
Inc fecal fat= malabsorption, pancreatic insufficiency or bacterial overgrowth Norm fecal fat= lactose intolerance, Sorbitol/Lactulose laxative abuse
46
What are the next steps/considerations if chronic diarrhea PT has a normal osmotic gap?
Normal stool weight= IBS or factitious diarrhea Inc weight= secretory stool weight
47
For diarrhea to be considered "chronic", it must be present for how long? What are the common causes that must be immediately ruled out?
Longer than 4wks Meds Chronic infections IBS
48
What are causes of chronic diarrhea?
``` Osmotic/secretory diarrhea Inflammation conditions Meds Malabsorption syndromes Motility disorders- IBS Chronic infections Systemic disorders ```
49
What are the Hx questions for Chronic Diarrhea?
``` Continuous / intermittent Relation to meals Nightly occurence? Fasting occurence? Appearance Ab pain/cramping Meds Weight loss Stressors ```
50
What are the most common causes of chronic diarrhea and need to be ruled out prior to work up?
Meds IBS Lactose intolerance
51
What findings/Sx are inconsistent with the most common causes of chronic diarrhea and warrant further evaluation?
Nocturnal diarrhea Weight loss Anemia Pos FOBT
52
What is the first part of the work up for chronic diarrhea?
Exclude most common causes (Med, LI, IBS) | Evaluation directed at most likely etiology based on Sx and Hx
53
What are the lab tests for Chronic Diarrhea?
``` CBC Chem 17 LFT Thyroid studies ESR CRP ```
54
What stool studies are ordered for chronic diarrhea?
``` Culture Leukocytes Lactoferrin Occult blood O&P E+ ```
55
Why is a colonoscopy with biopsy warranted for a chronic diarrhea PT? What are the "other" tests that can be ordered?
Exclude IBD and neoplasm 24hrs stool collection- total weight/total fat
56
What are the clues for Osmotic Diarrhea
Stool volume decreases w/ fasting | Increased osmotic gap that resolves with fasting
57
What are the etiologies for osmotic diarrhea?
*Carbohydrate malabsorption- consider in all Pts w/ chronic posprandial diarrhea, ask about dairy/artificial sweetener intake Lax abuse Malabsorption syndrome
58
How is Osmotic Diarrhea identified?
Elimination trial: Laxative abuse, malabsorption
59
Diagnosis of carb malabsorption can be established after how long of an elimination trial?
2-3 wks or, | H breath test
60
What are the most common causes of Osmotic Diarrhea?
Carbohydrate malabsoprtion- lactose, fructose, sorbitol Laxative abuse Malabsorption syndromes
61
Osmotic diarrhea resolve during ___ and are characterized by ?
Resolve during fasting Characterized by- abnormal distension, bloating, and flatulence from inc colonic gas
62
What is the definition/criteria for Secretory Diarrhea?
+1L/day Normal osmotic gap that doesn't change w/ fasting Inc intestinal secretion and/or decreased absorption
63
What are the etiologies of Secretory Diarrhea?
Endocrine Tumors | Bile Salt malabsorption
64
What are the clues of inflammatory chronic diarrhea?
Fever Hematochezia Ab pain
65
What are the causes of inflammatory diarrhea?
IBDz- Crohn's, Ulcerative colitis Microscopic colitis Malignancy- lymphoma, adenocarcinoma
66
What types of meds can cause chronic diarrhea?
``` SSRs NSAIDs PPIs ARBs Metformin Allopurinol ```
67
What are the clues for malabsorption from diarrhea?
Weight loss Fecal fat >10g/24hrs Abnormal labs
68
What are the clues of motility diarrhea?
Systemic dz or ab surgery Systemic= DM, scleroderma, hyperthyroid, IBS Pain/altered bowel habis w/o evidence of organic dz
69
What are the clues for chronic diarrhea?
Parasites or AIDS Parasites= Giardia, E Histolyitca, Cyclospora or intestinal nematodes Systemic= Thyroid Dz, Diabetes
70
Define Factitious Diarrhea
Osmotic diarrhea subset from magnesium (laxatives and anti-acids)
71
What are the initial diagnostic tests for chronic diarrhea in order of sequence?
Routine lab tests Routine stool studies Endoscopic exam
72
What are the lab tests ordered for chronic diarrhea?
``` CBC Serum E+ Liver chemistry Ca, PO4 Albumin TSH Vit A and D levels INR, ESR, CRP ```
73
Most PTs with chronic diarrhea and ALL pts with signs of malabsorption receive what lab test?
Celiac Dz- IgA tissue transglutaminase
74
Anemia can occur in which malabsorption syndromes?
Folate Fe deficiency Vit B12 Inflammatory conditions
75
Hypoalbuminemia is present in what conditions?
Malabsorption Protein-loss enteropathies Inflammatory dz
76
Hyponatremia and nonanion gap metabilic acidosis occur in what type of diarrheas?
Secretory
77
Inc ESR or CRP suggests what GI issue?
Inflammatory bowel disease
78
What are stool samples examined for during a chronic diarrhea PTs?
``` Ova/parasites E+ Sudan stain for fat Occult blood Leukocytes/lactoferrin ```
79
Cryptosporidia, Giardia, E Histolytica and Cyclospora may be diagnosed how?
Stool Ag or, | Microscopy
80
Pos fecal fat stain indicates what? | Presence of fecal leukocytes or lactoferrin suggest ?
Malabsorption disorder Inflammatory bowel dz
81
Endoscopic exams for chornic diarrhea are perfromed to exclude ?
Inflammatory Dz- Crohns, Ulc. Colitis Microscopic colitis Colonic neoplasia
82
When are upper endoscopy performed on PTs with chronic diarrhea?
Abnormal labs/pos fecal occult suggest small intestinal malabsorptive disorder (Celiac, Whipple) AIDS to document Crypto/Microsporidia or M Aviumintracellulare infection
83
What further studies can be performed when chronic diarrhea causes are not apparent after the first three standard tests?
24hr stool collection quantification of weight/fat X-ray/CT Serological Screening for Neuroendocrine tumors Breath tests
84
Stool samples with weights less than 200-300g/24hrs excludes ? and suggests ?
Excludes diarrhea | Suggests functional disorder- IBS
85
Stool samples with weights more than 1000-1500g/24hrs suggests ?
Suggests significant secretory process- neuroendocrine tumor
86
Fecal fat exceeding 10g/24h suggests?
Confirms malabsorptive order
87
Fecal elastase less than 100mcg/g may be caused by ?
Pancreatic insufficiency
88
Abdominal x-ray on a PT with chronic diarrhea showing calcification confirms what Dx?
Chronic pancreatitis
89
What antidiarrheal agents can be used in PTs with chronic diarrhea?
``` Loperamide* Bismuth subsalicylate* Diphenoxylate w/ atropine Codein/Deodorized opium tincture Clonidine Bile salt binders ```
90
What are the signs of an upper GI bleed?
Hematemesis- bright red blood or coffee grounds Melena in most cases Hematochezia in massive upper GI bleeds Possible pain- epigastric, abdominal
91
For upper GI bleeds, how is the amount of blood loss determined?
Volume status | HcT is poor early indicator
92
What are the four types of GI bleeds?
Upper Lower Obscure | Occult
93
What are the essentials of Dx for acute upper GI bleeds?
Hematemesis Varying hypovolemia Possible melena Hematochezia in massive bleed
94
What are the etiologies of acute upper GI bleeds?
PUD Portal HTN= esophageal varices Mallory Weiss tear- strong association with alcohol abuse Vascular abnormals Neoplasm Other- erosive gastritis/esophagitis/Booerhave Synd
95
What is the most common presentation of upper GI bleeds?
Hematemesis or melena Melena from 50-100mL of loss Hematachezia reqs 1L Severe upper GI bleeds present with hematochezia in 10% of cases
96
Upper GI bleeding is self limited in __% of PTs while the rest of PTs require?
80% | Rest require urgent medical therapy and endoscopic evaluation
97
What type of PT have a low risk of recurrent bleeding?
PTs w/ bleeding more than 48hrs prior to presentation
98
Initial eval/treatment for upper GI bleeds?
Stabilize- SBP below 100mm or HR above 100bpm= high risk
99
If upper GI bleeds do not need blood transfusion, what next step is considered? What do you not do?
NG tube- useful in assessment and triage Aspiration of red blood/coffee grounds confimrs upper GI source NO GASTRIC LAVAGE
100
What meds are given/used for upper GI bleeds?
Erythromycin 250mg IV 30min prior to gastric emptying
101
Did not add any cards
Below blood replacement of Upper GI BLeed
102
Clinical predictors of increased risk of rebleeding and death include what factors?
``` +60y/o Comorbid illnesses SBP below 100mm HR +100bpm Bright red blood NG aspiration or rectal exam ```
103
What are the characteristics of the High/Low risk PTs after upper GI triage?
High: Admit to ICU, endoscopy performed in 2-24hrs Low: admitted to step down unit/ward Non-emergent endoscopy within 12-24hrs
104
PUD ulcers account for __% of major upper GI bleeds with a _% mortality rate Portal HTN accounts for _% Mallory Weiss tears ?%
40% at 5% 10-20% 5-10%
105
What are the most common cause of vascular anomalies of GI bleeds?
Angioectasias- distorted vessesl from chronic/intermittent obstruction of submuccosal veins most commonly in R colon
106
What are the causes of gastric mucosal erosions that can lead to erosive gastritis and upper GI bleeds?
NSAIDs Alcohol Severe medical/surgical illness
107
What are the steps of care if PT presents as unstable during an upper GI bleed?
Start IV CBC, PT/INR, CMP, Type/Screen Fluid/blood replacement- isotonic fluid, 2-4 units NG tube
108
EGDs are warranted for which upper GI bleeds?
ALL with active bleeds within 24hrs of presentation
109
What are the three benefits of an ednoscopy in an upper GI bleed?
ID source Determine re-bleed risk Intervene- cautery, vasoconstrict, band/clip Homeostasis
110
What is the follow on pharmacotherapeutic care fo upper GI bleeds?
PPI- reduce rebleed risk factors | Octreotide- red BP and risk of re-bleed risk
111
What is defined as mild lower GI bleeding?
Bright red blood dripping into bowl or is mixed with brown stool Eval'd on outpatient setting
112
What is the etiology of lower GI bleeds?
IBDz- especially ulcerative colitis
113
What are the other S/Sx of lower GI bleeds?
Ab pain Tenesmus Bleeding from occult to recurrent hematochezia
114
Brown stools mixed/streaked with blood predict the source being where?
Rectosignmoid or anus
115
Large volumes of bright red blood suggest a bleeding source where? What if blood is maroon color?
Colonic source | Maroon- lesion in R colon or small intestine
116
Painless large volume lower GI bleeds are indicative of ?
Diverticuli bleed
117
What type of lower GI bleed is a colonoscopy the preferred initial study?
Acute large volume bleeds requiring hospitalization
118
Treatment for all lower GI bleeds includes?
Triage/Stabilization | Blood replacement
119
What are the purposes and perks of a therapeutic colonoscopy?
High risk lesions treated endoscopically w/ epinephrine injection/cautery/metal clips or TC-325 powder
120
What is the major common side effect/reaction to a lower GI bleed endoscopy?
Ischemic colitis- 5% | Re-bleed- 25%
121
When is surgical treatment indicated for PTs with lower GI bleeds? What usually causes this type of bleeds?
Ongoing bleeds requiring more than 6 units of blood in 24hrs or, 10 total and endoscopic treatment has failed Caused by bleeding diverticulum or angioectasia
122
Surgical treatment may be a consideration for diverticulum PTs meeting what criteria?
Two or more hospitalizations for diverticular hemorrhage
123
Define Anorectal disease
Hemorrhoids, fissures; usually cause small amount of red blood on TP or streaking in bowl Hemorrhoids in 10% of admitted PT w/ lower bleeds
124
Rectal ulcers usually present in what PT population?
8% of elderly or debilitated PTs w/ constipation
125
What PT population is ischemic colitis usually seen in?
Older PTs with atherosclerotic disease Younger= vasculitis, coagulation disorder, estrogen therapy, long distance running
126
What S/Sx will a PT with ischemic colitis present with?
Hematochezia or bloody diarrhea w/ mild cramps where bleeding is mild/self-limited
127
What does radiation induced proctitis cause after a time delay?
Anorectal bleeding revealing telangiectasias
128
What are all of the etiologies of lower GI bleeds?
``` Diverticulosis Angioectasias- common +70y/o Neoplasms IBDz Anorectal Dz- hemorrhoid, fissure, ulcer Ischemic/infection colitis Other- telangiectasias ```
129
Bleeding from the small intestines can be ? or ? but manifest as ?
Overt or occult | Melena, maroon stools or bright red blood per rectum
130
What is the most common cause of small intestinal bleeds in PTs younger than 40?
Neoplasms- stromal tumor, lymphomas, adenocarcinoma or carcinoids Crohns Dz Celiac Dz Meckel Diverticulum Also occur in PTs +40 but angioectasias and NSAID induced ulcers are more common
131
Define occult bleed
Bleeding not apparent to PT, can be less than 100ml/day and not cause any changes in stool
132
How are occult bleeds found in adults?
Pos FOBT FIT- only detects lower bleeds Fe deficiency anemai
133
What are the most common causes of occult bleeds with Fe deficiency?
``` Neoplasm Vascular abnormality Acid-peptide lesion Infection Meds IBDz ```
134
Majority of acute lower GI bleeds arise from what part of the GI system?
Colon | Lower risk of serious blood loss than upper GI bleed
135
Most likely consideration for PTs less than 50y/o and have lower GI bleeds?
Anorectal Dz IBDz Infectious colitis
136
Most likely considerations for PTs over 50y/o and have lower GI bleed?
Diverticulosis Malignancy Angioectasias Ischemic Colitis
137
Bright red blood = ? source Maroon color? Black?
Left colon- hemorrhoids, fissures, diverticulitis, IBD, colitis Sm intestine or R colon Upper GI
138
Painful defecation/rectal pain means what issues?
External hemorrhoids | Anal fissure
139
Abdominal pain/cramps means what types of issues?
IBD | Colitis
140
Painless bleeding is caused by ?
Internal hemorrhoids | Diverticular bleeds
141
Small volumes of blood loss indicate what issues?
IBD- bloody diarrhea | Hemorrhoids
142
What labs are drawn for acute lower GI bleed?
CBC CMP Anemia is ominous sign, particularly for suspected neoplasm
143
What is the diagnostics testing methods for acute lower GI bleeds?
First exclude upper GI source ``` Anoscopy Sigmoidscopy Colonoscopy Technetium scan Angiography Capsule endoscopy ```
144
What are the treatment methods for acute lower GI bleeds with large volumes of blood loss?
Therapeutic colonoscopy- vasoconstrictive band, cautery and clips/bands Intra-arterial embolization Surgery- +6 units in 24hrs or ten total
145
Occult GI bleeds must have what lab drawn to check for what?
CBC for anemia
146
PTs w/out + FOBT and no anemia= ? | PTs with +FOBT and anemia= ?
Colonoscopy | Upper endoscopy and colonoscopy
147
Who normally has no or some peritoneal fluid?
Men- o | Women- 20mL depending on cycle
148
What are the two broad categories of ascites?
Associated w/ normal peritoneum | Due to Dz peritoneum
149
What is the most common cause of ascites?
Portal HTN 2* to CLDz (80% of PTs with ascites)
150
What is the most common cause of nonportal HTN ascites?
Infections- TB Intrabdominal malignancy Inflammatory disorder Ductal disruption- chylous, pancreatic, biliary
151
What are the S/Sx of clinical findings for ascites?
Inc girth | Pain may be present depending on cause
152
What questions need to be asked to ascites PTs?
``` Liver dz ETOH consumption Transfusions Tattoos Injection drugs Hx of viral hepatitis/jaundice Born in hepatitis endemic area ```
153
Fever in a PT with ascites indicates what issue?
Infected peritoneal fluid (bacterial) | PTs with CLDz and ascites are at greatest risk for developing spontaneous bacterial peritonitis
154
What type of ascites need to be considered if PT is an immigrant, immunocompromised, or malnourished alcoholics?
TB peritonitis
155
Define Budd-Chiari Syndrome and when would it be found?
Thrombosis of hepatic vein | During ascites work up/PE
156
What are the lab tests for ascites?
Abdominal paracentesis | Routine- albumin/total protein
157
What imaging methods are performed for ascites PTs?
Abdominal US | CT/US can distinguish between causes of portal / nonportal HTN ascites
158
When are laparoscopy procedures in ascites PTs?
PTs with nonportal HTN ascites (low SAAG) | Mixed ascites
159
What are the etiologies of ascites?
Spontaneous bacterial peritonitis Malignant ascites Familial Mediterranean Fever
160
Stopped at
Etiology of Acites

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